Prostate Cancer Screening: Advanced Tests to Consider Before a Biopsy

By Dr. David Samadi

Early detection of prostate cancer has been a game-changer, saving countless lives. Identifying cancer in its earliest stages significantly boosts survival rates, and for prostate cancer, one of the most common screening tools is the PSA (prostate-specific antigen) test. This simple blood test measures the level of PSA, a protein produced by both cancerous and noncancerous prostate tissue, in the bloodstream. Elevated PSA levels can indicate prostate cancer, but they can also result from other conditions, such as an enlarged prostate or inflammation, making the test less definitive on its own.

When a PSA test indicates high levels, many men are referred for a prostate biopsy. While biopsies can confirm the presence of cancer, they are invasive and carry risks like pain, bleeding, infection, and anxiety. Moreover, fewer than half of prostate biopsies detect cancer, meaning some men undergo the procedure unnecessarily. Fortunately, newer screening tests are providing more nuanced information, helping physicians decide if a biopsy is truly warranted.

Here’s a closer look at advanced screening tools that can guide decision-making before proceeding to a biopsy:

Prostate Health Index (phi)

The phi test is a blood test that combines three measurements: total PSA, free PSA, and (-2) pro-PSA (p2PSA), a form of PSA linked to malignant prostate tumors. By analyzing these components, the phi test helps reduce unnecessary biopsies.

Key Insights: A 2017 study found that phi scores influenced treatment decisions in men with PSA levels between 4 and 10 ng/mL in 73% of cases. A low score often led to avoiding a biopsy, while a high score indicated the need for one.

4Kscore

This test evaluates total PSA, free PSA, intact PSA (a marker for prostate cancer), and human kallikrein 2, a related protein. It also considers factors like age and digital rectal exam results.

Key Insights: Research in 2017 showed that using the 4Kscore influenced physicians’ recommendations for nearly 90% of men and reduced biopsies by 65%.

Multiparametric MRI

The use of multiparametric MRI is growing as a pre-biopsy tool. This imaging technique provides a detailed view of prostate anatomy, cellular structures, and blood supply.

Benefits

• Identifies men who may not need a biopsy.
• Pinpoints tumor locations, allowing targeted biopsies and reducing the risk of missing high-grade cancers.
• Detects potentially lethal tumors traditional biopsies might miss.
• A 2017 study (PROMIS trial) revealed that multiparametric MRI reduced unnecessary biopsies by one-third and identified 18% more aggressive tumors than standard biopsies.

Other Emerging Assays

Additional advanced tests, such as the Mi-Prostate Score (MiPS), ExoDx Prostate (IntelliScore), and SelectMDx, are gaining traction. These tools use urine or blood samples to assess genetic and molecular markers associated with prostate cancer risk.

Discussing Options with Your Physician

If you’ve been diagnosed with an elevated PSA, it’s essential to have a thorough discussion with your healthcare provider about these advanced screening tools. Factors like the availability of tests, insurance coverage, and the current state of clinical evidence should be part of the conversation.

Remember, every man’s situation is unique, and decisions about further testing or biopsies should be personalized. Working closely with your physician ensures you make the choice that’s best for your health and peace of mind.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of Prostate Cancer, Now What? and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.